Mom fell and broke her hip because of a cord left in an area she was permitted to access. Her only solace was walking and now she is confined to a wheel chair or a "comfy chair". She had to have a plate put in her hip and now she can no longer walk. She is confused and combative because she doesn't understand that she can't just get out of her chair and walk. The nursing home dumped her on the local hospital emergency room and expect them to find a psychiatric geriatric unit to help adjust her meds so she won't be so agitated. The nursing home says, they do not have the staff to watch her constantly so she doesn't get up and fall again. They put her in this situation with their negligence and now they don't want to deal with her issues. No one will take her due to her medical condition. They truly just dumped her. This is heartbreaking, she is so scared and confused. I have no idea how to help her. She is in the hospital and they are trying to find placement for her in a geriatric psych ward. I do not understand how a dementia ward in a nursing home can not deal with a dementia patient!! Would really like to hear if any one else has dealt with this issue.

57 Answers

My advice as someone who has had some experience with loved ones in NH with dementia is document as much as you can in writing. Always keep copies of records. Document care plan meetings including medication changes and email a copy of what was discussed and agreed to the DON or admin. Try to take a witness with you like a trusted family member or friend to these meetings too. Do not just rely on the Ombudsman. Ombudsmans can many times become too friendly with the lousy staff.If a serious problem with care of a loved one arises put it writing and document asap and send it to the facility or DON. You will find quickly what type of facility your dealing with if an effort is made to solve the problem when a serious concern is in writing.Also, a serious well documented complaint with supporting back up documentation stands a better chance of accountability by the States Bureau of Licensure. Don't be afraid to appeal their decisions and expect to appeal. Nurses and DONS who back up lousy care or look the other way are putting their license at risk. True most facilities will rarely shut down. Although, a nursing license can be revoked, criminal liabilities do exist for neglect and abuse and lawsuits can be fought favorably with good supporting documentation.

I am a registered nurse who previously worked in Psychiatry. No, it is not "completely illegal" to use a restraint on a patient. In fact, as long as the restraint is ordered by the MD with good reason, it is legal. If a patient is assaulting other residents, that patient is a danger to others and it is unfair to allow that resident to continue the behavior. The patient may be physically or chemically restrained by physician order.

I went through this with my late father, who had vascular dementia. He began assaulting the other residents by yanking out their hair deliberately. So, I agreed to a "chemical restraint" of low-dose Ativan. Yes, it made him less functional - but the result was that both he and the other residents were safer.

Not all nursing homes provide the same level of care - and this is regulated by each state. A NH that is licensed as "rest home" basically only provides custodial care - feeding, bathing, light supervision, basic medical care. One needs to be in a "skilled nursing facility" to receive a higher level of care or a NH with several specialized units.

Gero-Psych patients are the most difficult to place anywhere, because they have both dementia and mental illness (e.g. bipolar, schizophrenia).

Finally, another consideration is that NHs that accept a large percentage of Medicaid-only paying patients are woefully understaffed. I think some adult children have the mistaken notion that their elderly parent is going to have some kind of one-on-one supervision 24/7 - which is not possible in a place with just one LPN for every 25 residents and a few aides. Even in one's own home, it is not possible to supervise an elderly parent at every single second of the day and accidents may happen. You might go to stick a load of laundry in the washer, turn your back for one minute, and your parent falls out of their wheelchair and breaks a hip.

The geriatric psychiatric facility we found for my mother was excellent. They were able to adjust her meds and she was able to go to a memory care unit. Please give the psychiatric units a chance, I was reluctant initially but it was the best thing for our mother. You can take legal action against the facility if you really feel they were negligent but you do want to find a facility that welcomes your mother and will care for her the best way possible. It doesn't sound like the facility she was in was doing that.

However, a facility can place a client in psychiatric facility if their behavior warrants (i.e. hitting, yelling, screaming, verbally abusive (cussing), grabbing and scratching staff would all be included in behavior issues in addition to sexually inappropriate behavior.

Here is something else to consider when your mom gets settled into where she will be living. It helped my mom, and therefore me, to hire student nurses who had done their "clinicals" at the NH. I could only afford to do that a few times a week, but my mom was much calmer and happier when she had that companionship.Best wishes to you.

Christine73: Thank you! It was horrible. They tell her "maam, you're too well to stay here." LESS THAN 48 HOURS LATER, SHE SUFFERED A STROKE THERE! What is wrong with these people? I suppose that we could have sued, but my brother generally doesn't have the time of day for much of anything. And the NH did a CYA by calling me at the hospital where they had transported my mother asking if I wanted to do a bed hold. That would have been @ $410 a day!

We had this happen with my mom. The NH gave us no choice but to send her to a geri-psych unit for medication adjustment and while there they discharged her and would not take her back. I did get an Ombudsman involved and The State Board of Health. It was a very stressful time as the geri-psych unit was like "One Flew Over the Cuckoos's Nest" and it took several days to find another nursing home for her. Although the first home definitely broke the law...they were given a "slap on the hand" by the Board of Health and I nearly had a nervous breakdown during the process.

I have the same fear that this will happen if my mom has to be placed (she is combative with me when she is crossed or doesn't like what I say). Yes, I understand the under staffing. But one-on-one care is often the only answer but very expensive. My friend's upward expenses for the care of their mom her last 1-2 yrs was $20K! She ran through all of her assets very quickly and not much left in the end. For most of us, this expense wouldn't even be possible to sustain for any length of time.

I fear that any kind of NH that is willing to take on such a resident is not going to be too great (just over medicating them to oblivion) and leave them sit in front of a window somewhere scared, lonely, helpless. They will be just as understaffed and what kind of nurses, CNAs, aids want to deal with a NH full of these kind of residents as their everyday job. Very sad situation and I have no answers.

Two helpful answers posted earlier:1. consult with hospice2. consult with director and work with them as much as you can to get 30 days or your local hospital/doctor to find alternate NH care.

Not wanting to be the one to do this but, I was a CNA and the social worker at a small nonprofit nursing home, so I see both sides. 1.Unfortunately staffing is always a problem no matter how many people you hire. 2. State and federal regulations are so strict, that even though the facility would love to be able to have someone watch your loved one one on one, it just isn't possible and if the facility has too many falls, injuries, what not, they will get shut down. 3.In most states, 30 days notice must be given and the facility Must try to find another facility to take them in that time. If they are violent to staff and other residents then they must be placed at a different facility if the current one cannot protect your loved one, other residents, and staff, or face fines and the possibility of being shut down. Yes I know it isn't the perfect solution to what has happened, but in a perfect world your loved one would still be in their own home or at least living with family and not have to be in a facility in the first place. And yes I know I will probably get a lot of bad replies, but it is what it is and if the facilities get shut down, then where would everyone go?

I'm sorry for your loss but thank you for posting your story. I'm going through almost exactly the same thing and this week I called in hospice to help with my mom. You've reassured me that I made the right decision. I threw the nursing home for a loop because I made the call to hospice myself and it interfered with their plan to dump mom. The hospice team has been great so far.

UPDATE…Mom was sent to a geriatric psych facility. She was calm for awhile and returned to the nursing home. Her condition deteriorated quickly and she became combative again. At that point, we called Hospice, as not only her mood changed, so did her physical condition. She easily qualified for hospice care. They came to the nursing and took over. All unnecessary meds were removed and they took over her medication therapy. The nursing home was no longer permitted to ship her off to an emergency room when she became difficult without the hospice teams consent and had it been necessary, the hospice team would have made the arrangements to send her to the hospital. They were able to assist in keeping her calm. Honestly, they were wonderful. Mom passed quietly in her sleep last night. Her torment is over and finally she has peace. To those of you who commented on this thread, thank you so much for your support. And to those of you who have a loved one and are still dealing with this horrific disease, my heart is with you, I truly know what you are going through. Again, thank you all.

One more comment: there are nursing homes that will take her. Lots of people in my mother's dementia unit also have complex medical problems. I think a nursing home dementia unit would be preferable to a psych ward. Her condition is dementia, not mental illness. Tell them that.

Revisit: Google your states medicaid govt website, "SNF bed hold days". There you will see your moms rights, and the state rules and regs that MUST be followed by the NH. How many days your Mom can be the hospital and still guaranteed a NH bed to go back to. If the NH did not follow these guidelines, you have all the power. Also, I find that NHs and shady staff hate the media. So sorry. Where is Mom now?

First of all, I'm not surprised by this at all. Sounds like what my mom's NH in NY is trying to do to her. Second, by dumping her, they broke the law. They had a binding contract to care for your mom. They violated that. You have clear grounds to sue. Contact an attorney that specializes in elder law. Explain what happened, and that you want to sue for breach of contract, and ask if he'll take your case on a contingency basis, meaning that he only gets paid after you get your settlement. I don't know if you even want your mom in that facility, but the money you get from this case should give you some breathing room. It stinks that everyone is sorry you're going through this, but it's almost impossible to find answers or help you can trust. The people at my mom's NH are all shady (ESPECIALLY the social worker) and they're in cahoots with each other. This is the reality of nursing home care. I will say, however, that if you talk to the head of your local ombudsman program (NOT just the ombudsperson assigned to your NH or hospital) you WILL get straight answers about what they legally can and cannot do. Maybe start there, but be warned, sometimes long-term ombudspeople develop friendships with these terrible people in nursing homes who snow them by pretending to be nice and helpful. Just watch your back. It may even be worth it to speak to an ombudsperson from another county to be sure they are not also in cahoots. If I sound paranoid, ask yourself why. Good luck to you. You are NOT alone.

The fact that Mom broke her hip due to negligence is reason for further investigation and mandatory reporting to the state. The NH is REQUIRED to report her fall to the state themselves. A SNF cannot discharge a patient without POA approval as long as the family/POA agrees to pay for the "bed hold days" not covered by Medicaid during her hospital stay. Has the POA agreed to pay for bed holds? If not, they can discharge her. Medicaid in Mass covers 10 days per year. That SNF apparently has broken a law or two and violated your mothers rights all over the place, from what I have read. A NH gives 24 hour care by law. I can tell from experience that the NH doesnt want to pay the salary of an individual aid they are REQUIRED to provide as 1 on 1 for companionship to watch your mom when she needs constant monitoring. It all boils down to money. Your Mom needs her own aid in her own room at times and the NH doesnt want that extra expense. god bless, where is Mom now? Also, it is up to the NH to find an appropriate place, but again, it depends on the bed hold agreement whether they can DC her or not. That form would be in the buz office folder. If you did not agree to pay for bed holds then yes they can discharge her, but if the form is signed that you WILL pay for bed hold days then they broke the law. I know your #1 priority is your Mom, but you may have a heck of a lawsuit, at least for their negligence, the cord left for Mom to trip over, and a HUGE one if you signed a form and agreed to pay for hold days.

My Farher became violent and I had to call 911 one evening to take him to the ER. The ER staff told me that he would need to be placed in a geriatric psych unit for evaluation. I trusted the staff to select a reputable facility but they placed him in a facility 2nrs from my home. By the time I had a day off from work to check on him, the facility had over medicated him to the extent that he couldn't stand, sit up, or speak. I didn't know anything abou psych units. I needed for the hospital social worker to find a safe place to evaluate my father. I was fortunate to know the head nurse of a skilled nursing home and she helped me get my father into her facility, nut it took my Dad a month to recover from the damage the psych unit did to him. He is in the local VA home now where he gets excellent care. I have been told by more than one nursing home social worker that a patient can be deemed to violent. I was told if my father were to become too violent, i would have to find a facility that would take him.

The staff in my late mother's NH were absolutely wonderful, always going the extra mile, however one of the residents will eventually have to be moved. He's a huge man, a former heavyweight boxer, and has severe dementia. Some of the time he's a pussycat but he often tries to punch people out of the blue. One time he held a door open for me, I smiled, said thank you and scuttled through just in case. It takes four aides to coax him into bed and he's punched some of them, putting one off work due to injuries. For the safety of the staff and other residents he will eventually have to be moved before someone gets seriously hurt.

when I was visiting nursing homes, a director of nursing confided in my that when a home wants to discharge a resident, they send them to the hospital and simply don;t hold their bed. When they're ready for discharge, their room has been taken by someone else. Sad that the place we send our loved ones when we can no longer take care of them, also is unable/unwilling to take care of them....

Yes, PAcaretaker, it happened to me, but the circumstances were maybe a bit different. Mom started throwing tantrums and the nursing home decided to move her to another building. Mom was at first happy about it, but soon enough she started to hate the new place - it did not help that there were a couple of residents there that took a strong dislike to Mom. At that time they also changed Mom's medication, which made her very drowsy - she could not walk any more - and gave her hallucinations. They finally sent Mom to the hospital where they adjusted her medication, and they ended up moving her back to the old place (but in a memory-care area). I am very distrustful of medication in general, but I have to say that the new treatment made all the difference. Mom has been doing much better since. She is walking again, and she seems both more peaceful and alert (even if the dementia is still there of course). I hope that your mom gets better.

With any kind of care facility, be it NH or daycare for your tot, you have GOT to interview them. Show up unannounced. Check their investigation & complaint file with the state department of human services. Every facility is going to have something in that file, and if it's more "self-reports" than anything else, that is a good sign they are keeping a close eye on themselves.

Use your eyes, ears, nose, and good sense to evaluate what you see. It is next to impossible for a facility of any size to put on a show all the time, every day. If the residents don't look clean, the place is a mess, it's not orderly, bright, and cheerful, then those would be red flags to me.

It's not going to look like a resort full of vacationers. The people in there have serious illnesses. Some of the are going to be asleep where they sit. Some are going to be feisty and arguing like little children. Others are going to be talking to somebody invisible. Yes, some will holler and yell. Especially in a dementia unit. You will hear somebody calling out "Nurse! Nurse! Nurse!" the entire time. There is a lady on my mom's unit who does this every waking second, every day, regardless of how many nurses attend to her. It is not a sign something is desperately wrong that everybody is ignoring. It means they are not medicating her to the edge of consciousness. Imagine working there all day long.

If the place has been open a long time, that is a good thing.

It's not going to look like the marketing brochures. If it did, I'd want to know why those healthy looking people need to be in a residential long term care place.

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